Written evidence submitted by the Approved Mental Health Professional (AMHP) Leads Network (MHB0057)
1.1 The AMHP Leads Network is a self-organised, peer-led, community of interest that provides advice and support to Approved Mental Health Professional (AMHP) Leads and AMHP services across England and Wales. The Network’s Steering Group works in partnership with the Black and Minority Ethnic AMHP Forum and the AMHP Research Network, along with representatives from the Department of Health and Social Care, the Association of Directors of Adult Social Services, and Social Work England, amongst others. The Network consists of representation from over 90% of English Local Authorities, several Welsh Authorities, 23 NHS Trust and 16 HEIs. The Network is concerned with all matters relating to AMHP practise and the operational and strategic challenges faced by AMHPs and AMHP services nationwide.
1.2 AMHPs are those professionals tasked with applying the statute and principles of the Mental Health Act for all age groups and all types of mental health condition. AMHPs consider the making of applications to detain under the Act. They also have a duty to consider whether to agree to legal restrictions being placed upon individuals in the community in certain circumstances. At every stage of their work, AMHPs seek to explore and secure viable alternatives to such compulsion by working with family, carers, professionals, non-mental health agencies and the individual themselves.
1.3 In undertaking their role, AMHPs act independently of their approving authority and carry an individual liability for their decision making – a necessary and vital feature of that role. This work is carried out 24 hours a day, 365 days a year. Any amendment to statute represents potentially significant change to the effectiveness of the role and the experience of those subject to the Act.
1.4 AMHP work is recognised as highly stressful, yet remains key to the safeguarding of those who find themselves in mental health crisis, be it in their own homes, police custody, places of safety or hospital environments. Demand for AMHP involvement has increased annually and their work is carried out against of backdrop of challenged resource provision and heightened acuity in the community. AMHPs are highly trained, skilled and experienced in the operation of the relevant legal frameworks in mental health[1]. They pay particular attention to the individual’s human rights and least restrictive principles, while also being responsible for organising many of the practical considerations around such arrangements.
1.5 In preparing this submission, the AMHP Leads Network Steering Group, has engaged with the wider network and partners. Individual AMHPs, Lead AMHPs, AMHP Services, and Regional AMHP Forums have also been encouraged to provide their own submissions on specific issues of concern and, as a Steering Group, we support those views being considered alongside those presented here.
1.6 The AMHP Leads Network welcome the opportunity to continue to support the work of the Select Committee in the developing new mental health legislation in line with the aims of the Mental Health Act Review.
3.1 We note the new definitions of the above terms and identify that the distinction between “mental disorder” and “psychiatric disorder” is being made to ensure certain provisions of the Act that will exclude autism and learning disability. We are unsure why the term “relevant disorder” has been created for Part III in that it appears to have the same scope as the term “mental disorder” – it includes psychiatric disorder plus autism and learning disability.
3.2 Is there a specific need to create this new term - if not, we submit that it would be simpler to allow the same term of “mental disorder” to carry through into Part III?
3.3 We note that the inclusion of learning disability as a grounds for detention or guardianship is with the additional criteria that it must be associated with ‘serious behavioural consequences’. We believe that this is appropriate and that detention should not ordinarily be the route by which people with learning disability access care and support, and should only be considered in the most serious situations where individuals cannot be supported in another way.
3.4 We note that no such additional criteria exist for the grounds of autism? We find this to be of concern and believe that similar additional criteria should be included to ensure that detention or guardianship are only sought in cases where there are significant risks related to behavioural presentation that cannot be supported by any other means.
3.5 We welcome the aim to ensure treatment provided has some therapeutic benefit.
3.6 We have some concerns that there is a risk, in practice, that this definition may allow for the exclusion of particular groups of people, e.g., in cases of complex need and risk, and repeat presentations that are not easy to resolve or treat, such as emotional crisis, personality disorder, complex PTSD.
3.7 The definitions of “mental disorder” and “medical treatment” were amended in the 2007 Act to ensure that there were no longer ‘diagnoses of exclusion’. We submit that clear guidance will be required to ensure that busy mental health services seeking to manage their workloads will not utilise this criteria as a tool to reduce the level of service provided to those presenting with such complexity.
3.8 We note that section 19(2)(d) continues to allow for the transfer from guardianship to a hospital for treatment under section 3. While the addition of section 19(2A) makes amendments to the duration of this in line with the amended duration periods, we cannot see anything to represent the exclusion of people with learning disability and autism from these arrangements.
3.9 Is this intentional? We submit that this exclusion should be added to avoid transfer from guardianship to hospital becoming a ‘back door’ route to a longer term hospital detention?
3.10 We note that the grounds for detention have changed. While we broadly support the tightening of the criteria, we note the addition of a new ground:
serious harm may be caused to the health or safety of the patient or of another person unless the patient is so detained;
3.11 Previously, detention could only be in relation to the person’s own health or safety or protection of others. This new wording appears to allow for detention on the basis of another person’s health, which was not previously the case.
3.12 We are concerned this is a ground for detention is unrelated to the individual’s own health or treatment need. This could result in individuals being detained purely in relation to the needs of others, for example a carer experiencing burn out, rather than for the individual own clinical need. While impact on the individual’s disorder or behaviour on others is always a consideration in the application of the Act, it should not, we feel, be a ground in its own right. This would not fit with the overall aim of reducing detentions and the aim of focussing promoting an individual’s choice and autonomy.
3.13 In relation to risk assessment, the criteria of:
given the nature, degree and likelihood of the harm, and how soon it would occur, the patient ought to be so detained
AMHPs are acutely aware that resource pressures, particularly in relation to the availability of doctors, beds and ambulances mean that both assessments and admissions are often subject to long delays. Some consideration and guidance on how AMHPs are expected to evaluate these situations alongside the ‘how soon’ element of the criteria is required, particularly if there has been a significant delay in securing these resources and the assessed risk has not in fact transpired.
3.14 Is it expected that re-assessments under the Act in these circumstances may well be required and, if so, consideration needs to be given to the impact on the individual and AMHP service provision (this is linked also to the impact of delays in healthcare on AMHP services below).
3.15 We welcome the inclusion of a requirement for inpatient RC and community consultant to liaise in relation to the potential use of CTO. In practice, AMHP teams will require this liaison and agreement to have taken place before they are asked to consider agreeing to such an Order; therefore,
3.16 We submit that the criteria in section 17A(b) and (c) should to be switched, so that this more logical assessment process is encouraged and to reduce the demand on AMHP time, as clinicians may conclude amongst themselves that such an Order is not viable.
3.17 We submit that the CTO criteria should also be based on an evidenced history of the individual disengaging from services leading to significant harm and/or established relapse indicators, and not be read so as to allow unevidenced concerns to form the basis of an imposition of restriction in the community (as envisioned prior to the 2008 amendments).
3.18 We welcome efforts to require wider consultation on the establishment of CTOs with the Nominated Person and other relatives and carers.
3.19 In our reading of sections 17AA, 19(3)A, 20(5)(b), 20(6A), 20(8B) we find the Bill confusing and inconsistent. NP Consultation duties move between different professionals (i.e. CTO is RC for application and AMHP for renewal). At some points, the NP has the ability to make an objection, at other times they do not. What is the purpose of the consultation? This needs to be made clear.
3.20 At some points in the scheme there is the option not to consult the NP, where it is felt to be not practicable or involve delay. In other areas there is no option not to consult (e.g.20(5)(b)). What happens if there are significant barriers to consultation? Will the order expire? As CTOs are, by definition, planned pieces of work can ‘delay’ be relied upon if professionals fail to consult in a timely manner?
4.1 Nominated Persons and the role of the AMHP are fundamental to the operation of the Act. The proposals, as set, out contain many areas of significant concern for the Network. We provide a fuller account of the detail at Appendix 1.
4.2 The lack of such statutory provision is particularly concerning given a primary driver for legislative change was the need to address racial disparity in detained populations.
4.3 We identify that the unintended consequences of this change could include:
4.4 Practice changes to medicalise behaviours of communication and distress in people with a learning disability and/or autism in order to fulfil the new definition of mental disorder, and so open up access to section 3 detention.
4.5 The criminalisation of behaviours, distress, and communication styles for people with a learning disability and/or autism in order to resolve unmanageable community situations and maintain safety. This could also potentially increase the use of Part III orders.
4.6 Increases in the use of guardianship – see below
4.7 Increase in the inappropriate use of DoLS or unlawful deprivations, i.e. for those people currently detained in hospital who will no longer be able to remain, plus those people detained on new section 2 applications, who subsequently cannot be placed on section 3.
4.8 The community care market does not currently have available the care, support and accommodation required to support these groups of people. Adequate community resources are needed before this criteria can be introduced.
4.9 The creation of an inequality of entitlement – people with a learning disability and/or autism will now be less likely to qualify for section 117 aftercare as section 3 detention should decrease. The provisions of guardianship do not come with section 117 entitlement, but consideration of extending section 117 to all those subject to guardianship should be made.
4.10 While the impact assessment suggests an increase to section 7 guardianships are not expected, we believe the retention of this power for people with learning disability and/or autism will make it a potential route by which those currently detained may be moved on. Similarly, those not able to be detained and already in the community may be subjected to guardianship to offer professionals at least some kind of legal framework.
4.11 Guardianship orders are not used on a large scale currently and any increase, of even a moderate amount, will likely expose a wide range of process, policy, infrastructure and knowledge deficits that may cause significant resource issues for local authorities, health trusts and individuals.
4.12 Issues relating to MHA administration, access to the MHRT, time scales between application and acceptance and the provision of responsible clinicians are some of those we can predict will become problematic without proper consideration and clarity in the law and guidance.
4.13 We offer the following link as a useful exploration of the issues above in support of our view: Unintended consequences of taking people with learning disabilities and/or autism out of scope of the Mental Health Act 1983 | The Small Places (wordpress.com).
4.14 An area of significant concern to the AMHP Leads Network is the lack of ‘mirror duty’ placed upon agencies who are required to support the functioning of the Act. In particular, the current lack of legal imperative to provide section 12 doctors for Mental Health Act assessment interviews. Such an absence of medical availability greatly impedes the setting up of such assessments and the ability of AMHPs to fulfil their role. Delays of this kind routinely increase the risk to individuals and their families, and to those alone and unsupported in the community.
4.15 The AMHP Leads Network carried out a survey in September 2022 on the impact on AMHP services and delays to patient care as a result of the lack of availability of section 12 doctors. Please see https://padlet.com/AMHP_Leads_Network/kzbkqfs295bveo6y for those findings, which we submit re-enforce the need for serious consideration of including mirror duties in the statute.
4.16 At present, the only such duty in statute is the local authority’s responsibility to provide AMHPs to consider applications under the Act (section 13). There are no mirror duties placed upon key partners in health, policing, or elsewhere, to provide the necessary resources to deliver statutory processes, such as the securing and execution of warrants and transportation.
4.16 Please refer to the “National Workforce Plan for Approved Mental Health Professionals” (DHSC, 2019) for a further exploration of the resource issues impacting on undertaking timely MHA assessments.
5.1 The AMHP Leads Network believe that this Bill represents the best opportunity to correct historic oversights in the previous Act and to reflect changes in the landscape of mental health service provision and the experience of those ‘on the ground’. For the benefit of those subject to the Act and those who operate within it, the Bill should not be allowed to pass without further consideration being given to the issues raised above and the following:
5.2 We believe that the MHA principles should be enshrined into legislation and not left to reside in the Code of practice.
5.3 The Bill should introduce ‘mirror duties’ for health and ambulance trusts, courts and police, to ensure there are sufficient doctors, beds, transport, access to warrants and police support in the same way that local authorities are expected to provide sufficient numbers of AMHPs
5.4 Similarly, the Bill should promote clarity around the responsibilities of all agencies in supporting individuals, and each other, when there are delays in statutory processes.
5.5 The terminology around guardianship is antiquated and should be removed in order to place the scheme on a par with Community Treatment Orders (for example, for section 7 to be renamed “Community Welfare Orders” or similar, with greater statutory responsibility being placed upon all relevant agencies to support those individuals subject to the same).
5.6 Use of section 7 guardianship should come with automatic entitlement to section 117 aftercare.
5.7 The power to transfer a person under section 5(2) (‘doctor’s holding power’) to a more appropriate mental health facility should be included. This would mirror the power professionals already have at section 136 to transfer between places of safety and would ensure that general hospitals are not expected to look after mentally unwell people without a physical health component.
5.8 Clarify the role of the Social Supervisor in monitoring those subject to Part III (“Supervised Discharge”) and introduce clear guidance as to the level of training and expertise required to carry out the role.
5.9 The role of “AMHP Lead” to be given the statutory equivalence of Principle Social Worker in the Mental Health Act. Please see https://padlet.com/AMHP_Leads_Network/kzbkqfs295bveo6y for a Network discussion paper on this topic.
5.10 The development of guidance to AMHP and health service in cross boundary working in the revised Code of Practice. Please see https://padlet.com/AMHP_Leads_Network/kzbkqfs295bveo6y for a recent guide on this subject from the Network.
5.11 Provide clarity as to which professionals can and/or should undertake social circumstances report to the Mental Health Tribunal, in order to ensure a true social perspective on the individual’s situation is represented.
Signatories on behalf of the AMHP Leads Network:
Christina Cheney (Chair) Robert Lewis (Vice Chair)
16 September 2022
AMHP Leads Network – Nominated Persons Appendix 1
Submission to Joint Committee on the Draft Mental Health Bill
Schedule A1 Section 21, Part 1 and related proposed changes to Mental Health Act 1983
1.1. Approved Mental Health Professionals (AMHPs) are central to the operationalisation of the proposed Nominated Persons (NPs) arrangements. The concept of the NP, as with the Nearest Relative (NR) before it, represents a significant procedural safeguard for those under consideration of, or are subject to, the use of the Mental Health Act.
1.2. The AMHP Leads Network welcome the proposal to allow individuals to select their own NP when compared the current Nearest Relative arrangements, in which individuals have no choice as to which family member or significant person is engaged in the legal elements of their care.
1.3. The AMHP Leads Network broadly welcomes the introduction of the ‘AMHP nominated NP’ as a potential solution to situations where the individual has not previously appointed an NP and would lack the capacity to do so at the point of mental health crisis and possible admission. However, the removal of the ‘Interim NP’ concept (as described at the Review stage of reform), has weakened the potential effectiveness of this safeguard.
1.4. The AMHP Leads Network welcomes the introduction of the “relevant patient” concept, as it clarifies which individuals might require an AMHP nominated NP and in what circumstances.
1.5. The AMHP Leads Network is significantly concerned, however, that the mechanisms and formalities of the proposed scheme will greatly inhibit, rather than promote, individual choice in this area.
1.6. It is the view of the AMHP Leads Network that, in their present form, the NP proposals are operationally unworkable and that further development is required on this part of the Bill to ensure that the aims of the MHA Review are met and that the resulting Act is both workable and meaningful. It is important to ensure that professionals are not unnecessarily tied up with procedural and logistical matters and that they are able to focus their efforts of safeguarding individuals at times of heightened risk.
1.7. In order to support the Joint Committee’s considerations, we present below an overview of the issues and concerns in relation to the proposals set out in the Bill. We also set out a table that provides more detailed questions and issues that will require consideration as the Bill progresses.
2.1. The proposed formalities of appointment are hugely problematic. Signatures from individuals and NP require being witnessed in person. Individuals and nominees also require to have their suitability ascertained and verified by witnesses. No electronic signatures/confirmation appear allowable and, even if these were allowable, they would still represent a major barrier to timely NP appointments.
2.2. The proposals take no account of the geographic distance between the various actors. The logistics and time required to complete nominations lawfully would impact significantly on professional time and would be subject to many ‘real world’ delays (professional availability, inter-agency arrangements, and so on)
2.3. The proposals significantly risk placing increased demand on already stretched AMHP and other mental health services, as system partners will look to AMHPs in particular to resolve the lack of NP for non-capacitous patients in hospital - along with multiple other unintended consequences of the scheme (disputes over the validity of NP nominations and terminations, and so on). The scheme creates new legal challenges for professionals and works against the intentions of the Review.
2.4. The removal of “Interim NP” from the proposals has left clear gaps in the scheme as originally envisioned by the Review. It is likely that the number of NP appointments be will far fewer than intended and the proposals work against promoting uptake. This scheme, in effect, mirrors that of the Mental Health (Care and Treatment)(Scotland) Act 2003, which led to lower than hoped for numbers of “named persons” being identified due to appointment formalities. Some consideration could be given to the existing scheme (as at section 26) being utilised as the ‘fall-back’ position in the absence of a patient nominated NP (accepting that this is imperfect, but more likely to secure the procedural safeguard than the proposed scheme).
2.5. The Bill pushes NP appointment to be part of the MHA assessment interview process, which is logistically problematic, clinically inappropriate, and risks additional pressure on both the individual and assessing professionals. It takes no account of how MHA assessments and interviews take place in real time - which may well include police executing warrants to gain entry, the use of restraint, individuals being faced with professionals who are unknown to them, neighbours witnessing such events, and so on.
2.6. The scheme fails to take into account the practical realities of the circumstances individuals and professionals find themselves in. For example, a capacitous person (who had not previously nominated someone) could only realistically nominate someone who was present at the assessment interview, given the need for signatures and documents to be witnessed, roles to be explained, and so on. This is highly unlikely to happen, as often the person will not be aware of the assessment ahead of time, due to concerns over flight risks and risks to self and others. The potential nominee may live hundreds of miles away (or even abroad). This will mean that the individual, if admitted, will need to wait sometime after they arrive in hospital to avail themselves of the safeguards of the NP role. The original “Interim NP” proposals reduced that risk, as it was more akin to the Relevant Person’s Representative under the Mental Capacity Act’s Deprivation of Liberty Safeguards.
2.7. In a similar scenario, an AMHP could not nominate someone on behalf of the person if that person had the capacity to choose, as the scheme specifically excludes this. In practice such a nomination could be of benefit to the patient if the AMHP were not also bound into the same requirements around the witnessing and validation of nominations (the AMHP Leads Network has made suggestions relating to how such matters could be managed in line with current practices lawfully). It is our submission that the notion of capacity and incapacity with regards to these matters is unhelpful and creates unnecessary obstacles to securing the right NP in a timely manner for the individual.
2.8. Where the person lacks capacity, the proposed NP would need to be present or geographically very close by for the AMHP to complete the process. As the AMHP will be focussed on the welfare of the individual it would be virtually impossible to break away from that person’s care to carry out an additional procedure, which is more akin to the witnessing of a mortgage application than a clinical intervention. These procedural requirements risk undoing all of the good intent of the Review and the Bill in this area.
2.9. The Bill gives the AMHP multiple powers normally reserved for the courts around terminating NPs, including those nominated by the person in certain circumstances. This sits uncomfortably with the AMHP role and also the original aims of the MHA Review. It increases the risk of personal legal challenge to AMHPs.
2.10. The power of AMHPs to override NP objections to the use of section 3 on the grounds of “dangerousness” did not appear in the Review or White Paper and we are unclear as to inclusion here. It moves some of the power of a County Court Judge to AMHPs. While there are clear reasons to remove the County Court from situations that could reasonably be managed under the proposed scheme, or an improved version of it, this new power seems to move control further toward professionals rather than the individual.
2.11. It is uncertain how the requirement for AMHPs to notify relevant managers of their appointment of an NP will work in practice.
2.12. There is no indication at this stage of the need for national database of NPs, which would be the preference given the mobility of the population and need for multi-agency access to the latest information. It is assumed that any registers will be organised at a local level. This creates multiple issues with accessing, updating and managing databases, as not all local authorities and health Trusts will have access to the same records systems.
2.13. The proposals as they stand would require a heavily detailed Code of Practice due to reflect the multiple scenarios that arise from, what we view as, an incoherent legislation. It is unlikely that such guidance would cover every eventuality and increase the likelihood of AMHPs being challenged legally (remembering that the AMHP is necessarily independent of their authorities when carrying out duties under the Act and independently liable for their decision making).
2.14. The selection of AMHP nominated NPs would need clear support in any revised Code of Practice to ensure that issues of culture and race are specifically addressed. This awareness would also need to extend to other actors who are required to support these proposals in practice.
2.15. Significant investment is required in educative support for NPs (and patients) as to the nature and power of the roles, as well as logistics of operating such a scheme.
Schedule A1 Section 21 | Nominated Person
| Part 1
| Appointment of nominated person by a patient |
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Sub-heading | Effect | Summary of detail | General questions/comments | Impact on AMHP Practice/Workforce and resources |
Rights of patient etc to appoint nominated person Paras 1, 2 | A patient may appoint another person to act as NP for the purposes of this Act (1) | 2(1)
2(2)
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Appointment formalities Para 3 | Requires an instrument in writing, signed by the patient and the NP, in the presence of a health or care professional (not necessarily at the same time). | Valid if (1): a) the person is eligible b) The appointment is made in writing c) Requirements of 2 are complied with (2) The instrument in writing must a) Be signed by the patient in the presence of a health or care professional or IMHA b) Is signed by the NP (also witnessed) containing the statement that
c) Witness states:
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Duration of appointment (by patient) Para 4 | Appointment ceases of NP, if: | a) NP dies b) Patient appoints another c) Patient terminates the appointment (para 5) d) NP resigns (para 6) e) County court terminates (section 30B) f) An AMHP appoints another NP |
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Termination of appointment by patient Para 5 | Patient can terminate their own NP’s appointment via written notice | Notice must be:
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Resignation of nominated person Para 6 | An NP can resign their appointment in writing | Written notice must go to:
And, one of the following:
For those patients who are:
In relation to a patient who is
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| Part 2 | Appointment of nominated person by an approved mental health professional |
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Sub-heading | Effect | Summary of detail | General questions/comments | Impact on AMHP Practice |
Power of approved mental health professional to appoint a nominated person Para. 7 | The AMHP may appoint a person to act as an NP.
Introduces the “relevant patient” concept.
| Where an AMHP reasonably believes that a relevant patient (1):
The AMHP may appoint an NP
“Relevant patient” means a person who is (2): a) Liable to be detained in pursuance of an application for ss.2, 3 b) Subject to an application to detain c) Who an AMHP is considering making an application for ss.2, 3 d) A community patient e) Subject to Guardianship in pursuance of a guardianship application f) Who is subject of a guardianship application g) In relation to whom an AMHP is considering making a guardianship application |
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Who can be appointed by an approved mental health professional as a nominated person Para 8 | Sets out the same eligibility around age (as at para 2) and not having been disqualified by a court. |
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Selection of nominated person Para 9, 10 | Para 9 relates to over 16s Para 10 related to under 16s
| Over 16s
Under 16s If a person within the following list is willing to act as NP, the AMHP must appoint them
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Appointment formalities Para 11 | Sets out the requirements to ensure an AMHP NP is valid | The person is eligible to be appointed (as at para8)
The NP agrees Appointment is made in writing, signed by the AMHP
The AMHP must witness NP signature (“in the presence of the approved mental health professional)
Age requirements (as at Para 2) are met
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Notification of appointment Para 12 | Sets out the ‘must’ carry outs for AMHPs
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Duration of appointment Para 13 | Sets out the circumstances in which an AMHP nominated NP will cease to be such.
This includes patients being able to override the AMHP with a new nomination.
Ceasing to be a “relevant patient” itself, would end the nomination | a) When the NR dies b) An AMHP appoints a different NP c) An AMHP terminates the appointment under para 14 d) The patient terminates to appointment under para 15 e) NP resigns under para 16 f) County Court terminates the appointment g) The patient nominates a different NP h) The person ceases to be a relevant patient.
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Termination of appointment by approved mental health professional Para 14 | Sets out the process and parameters of ending an AMHP nominated NP’s involvement | Termination requires written notice to the NP, on the grounds that (2): a) The NP lacks capacity to act as an NP b) NP no a suitable person to act as an NP c) Patient has regained capacity or competence to appoint an NP
Where an AMHP terminates the appointment they must (3) a) Notify the relevant managers for ss.2,3 patients b) Notify the LA for s. 7 patients
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Termination of appointment by relevant patient Para 15 | Provides the process by which patients can terminate the appointment of the NP they have appointed. | Relevant patient must provide the NP with written notice (1)
The notice must be (2): a) Signed by the patient in the presence of health or care professional or IMHA b) Contain a statement by the witness that:
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Resignation of nominated person Para 16 | Describes how NP can resign from their appointment | NP may resign by giving written notice to the patient and at least one of the person listed in para 2:
a) An AMHP b) The RC (if any) c) The relevant managers for detained patients d) The relevant LA for guardianship patients.
The notice must be signed by the NP (3) |
| The primary issues here are the lack of NP register provisions/clarity. How in reality communication around these issues are handled – multiple service models, records systems, s.75/MoU/no agreement models hamper information availability.
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Mental Health Act 1983 | Chapter 20 | Part 1 | Summary of main changes relating to NP |
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General provisions as to applications Section 11 | Right to make an application transferred to NPs (1) |
| While minimal, NP applications to detain might end up with a ‘race’ between the patient seeking to terminate the NP’s appointment at the same time the NP is trying to detain the individual. |
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| 11(4) Wording change
| 11(4A) Consultation for ss.3 and 7 do not apply if: a) Not reasonably practicable, or b) Would involve unreasonable delay
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| 11(4B) Wording change | 11(4C) Where an NP objects to a ss.3 or 7 objection, the application may be made by an AMHP if they certify that – in their opinion – if not admitted/received the patient would be “likely to act in a manner that is dangerous to other persons or to the patient” |
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Duty of approved mental health professionals to make applications for admission or guardianship Section 13 | Remains as before, with NP replacing NR | Section 11(4) retains the “reasons in writing” if no application requirement for AMHPs |
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Community treatment orders: role of nominated person 17AA | 17AA(1) – Confirms that the RC must consult the NR | 17AA(4) – Provides the RC with an NP “dangerousness” over-riding power to objections. |
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Sections 26, 27, 28, 29, and 30 | All have been completely removed (replaced by Schedule A1) |
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Power of court to terminate appointment of nominated person 30B | County court retains redefined powers in relation to NPs
(2) Applications can be made to terminate NP appointments by: a) the patient b) an AMHP c) “any person engaged in caring for the patient or interests in the patient’s welfare”
| 30B(3) sets out the grounds: a) NP unreasonably objects to ss 3 or 7 application (presumably below the dangerousness threshold that an AMHP can disregard the objection) b) NP, without due regard for the welfare of the patient/public, has exercised the power of discharge c) NP unreasonably objects to making a CTO d) The patient has done anything which is clearly inconsistent with the NP remaining the NP e) NP lacks capacity/competence to act as NP |
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Remands to hospital: nominated persons 36A | Sets out that the nominated person scheme applies to those remanded under section 35 and 36 |
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Welfare of certain hospital patients Section 116 | Removes the duty (at section 116(2)(c)) to arrange visits to adult patients for whom the LA in NP
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For correspondence: robertlewis2@nhs.net
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[1] Department of Health & Social Care, 2019, National Workforce Plan for Approved Mental Health Professionals (AMHPs), London